“It’s everywhere”. In one sentence, OUTBREAK co-founder and managing director A/Prof Branwen Morgan highlighted a key reason that tackling antimicrobial resistance (AMR) is so complex.
Joining Caroline Duell, Andrew Bowskill and OUTBREAK’s Prof Antoine van Oijen for the World Antimicrobial Resistance Awareness Week episode of MTP Connect’s podcast, A/Prof Morgan clarified: “You can’t isolate or hide from antimicrobial resistance. The challenge comes down to the fact that AMR is not one thing – it’s a feature of infections. It’s not a single disease and is not as tangible.
“People can see what’s happening in COVID. They can put their masks on; they can receive instructions around what to do.
“What can you do to avoid an antimicrobial resistant infection? It’s a completely different scenario.”
The episode centred on OUTBREAK’s new report ‘A One Health antimicrobial resistance economic perspective’, endorsed by world-leading UK-based economist Lord Jim O’Neill. The report made sobering findings about the impact of AMR in Australia, forecasting a grim reality facing the country’s healthcare and economy if nothing’s done about ‘superbugs’.
Prof van Oijen said, “We used urinary tract infection (UTI) rates as a case study, and real-life data from the Illawarra-Shoalhaven Local Health District to model three scenarios, scaled up to the projected population of Australia in 2030.
“We discovered that UTIs will easily cost Australia more than AUD 1.1 billion a year within the next decade if we don’t tackle the threat of AMR now.”
A/Prof Morgan called drug-resistant UTIs the ‘canary in the coalmine’.
“Demand for emergency departments is already increasing by 5-10% per year. AMR will exacerbate hospitalisations and the knock-on to ICUs.”
She described OUTBREAK’s findings as ‘conservative’. “Our analyses didn’t include indirect costs to productivity or the economy, like sick days, for example – but illustrates the links between antibiotic-resistance, a type of AMR, and substantial hits to healthcare, industry and sectors like aged care, food production and agriculture – among others – if we don’t act.”
One Health platform technology and data-driven insights hold the key
OUTBREAK’s report threw up a number of answers to the question on ‘what can you do about antimicrobial resistant infection?’
Prof van Oijen explained. “What our studies show is that even with moderate decreases of resistance rates, there’ll be significant positive economic effects coming out of this, in terms of keeping Australians out of hospitals. As a society, we do overuse (antibiotics) – not just within the human health space, but in also in agriculture.”
He told MTP Connect, “Sensible approaches and stewardship (comes down to generating and having) the data; then being able to apply stewardship and sensible management of the resources we have, together with the development of new drugs, diagnostics and other technological innovations.”
A/Prof Morgan added, “We have greater computer processing power and different cloud solutions so we can link these datasets. We have incredible (data scientists) who are developing new algorithms to link antibiotic use with resistance patterns.”
Prof van Oijen agreed that gathering and integrating datasets is the answer. “With data-driven approaches, we have an opportunity to utilise the tools we have access to right now; we’re able to identify where the data-gaps are.
“We’re able to set up AI-driven frameworks to provide information to the people in the decision-making workflow who prescribe antibiotics, to help them prescribe in a more person and region-specific way.”
OUTBREAK Modelling
- UTIs will cost Australia more than $1B/year within the next decade if nothing is done to stop antibiotic resistant bacteria (superbugs)
- In Australia, UTIs account for over 2.5M GP appointments, 100K emergency department visits, and 75K hospital stays per year. They currently cost healthcare $909M from a patient perspective.
- If we don’t stop antibiotic resistance, that figure could hit $1.6B by 2030
- The OUTBREAK report models three scenarios scaled up to the projected population of Australia in 2030:
- AMR rates to a first-line antibiotic at their current level of 21%
- the cost of UTIs is AUD 1.1B
- AMR rates rising to 50%
- costs rise to AUD 1.6B
- AMR rates falling (though mitigation/intervention) to 10%
- costs fall to AUD 864M
- There are many gaps in current AMR data. The human and economic cost or AMR has not been fully recognised, but we have enough knowledge to show that AMR is a gathering storm that threatens a century of progress in medicine
Possible interventions
- Resistance to first-line antibiotics is a significant driver of costs. If we could address antibiotic resistance at the community level through GPs, we could save the public health system millions
- Potential One Health interventions to protect Australia from impacts of AMR include:
- exploring opportunities for reducing AMR exposure in the environment
- optimising wastewater treatment plants (processes to reduce evolution and spread of AMR?)
- vaccinating poultry
- better AMR data aggregation and surveillance to:
- identify superbug hotspots in real-time
- close gaps in knowledge
- improve understanding of AMR across society
- ensure comparable evaluation of potential benefits of intervention strategies and facilitate ‘smart prescribing’ – supporting GPs to prescribe the right antibiotic for the right patient, first time every time
- link data from GPs, emergency departments and hospitals, which is vital to assess true costs and impact of AMR
About OUTBREAK
OUTBREAK is a pioneering multi-institutional and transdisciplinary initiative helping solve the growing threat of antibiotic resistance by using AI to determine a location-specific and person-specific threat of a drug-resistant infection now and in the future.
OUTBREAK platform technology is a world first, high-tech surveillance system taking a One Health approach, gathering hundreds of diverse datasets across humans, animals and the environment and combining them to track, trace and tackle drug-resistant infections in real-time.
OUTBREAK insights can be used to reduce inappropriate use of antibiotics (smart prescribing), lower environmental contamination due to antibiotic residues, and provide decision-making support to GPs, healthcare administrators, governments and industry.
To find out more, follow us on Twitter @OneHealthAU.